In a woman with heart disease in the second stage of labor, which assessment findings are of greatest concern?

The assessment findings that indicate a potential exacerbation of heart disease, particularly during labor, include edema, basilar crackles (often indicative of pulmonary congestion), and an irregular pulse. These symptoms suggest possible heart failure or fluid overload, which are significant concerns in a woman with pre-existing heart disease.

Edema can signal worsening circulation and fluid retention, while basilar crackles typically indicate fluid in the lungs, a common complication of heart disease affected by the increased hemodynamic demands of labor. An irregular pulse may suggest arrhythmias, which can occur due to the stress on the cardiovascular system and might lead to serious complications if not monitored closely.

In contrast, the other answer choices present assessment findings that might not pose as immediate threats. Increased urinary output and tachycardia could indicate good renal function but are not as critical concerns as pulmonary symptoms. Shortness of breath alongside bradycardia and hypertension are concerning but do not include the critical indicators of fluid overload like basilar crackles. Regular heart rate with hypertension also lacks the indicators of acute complications seen with pulmonary issues.

Thus, the combination of edema, basilar crackles, and an irregular pulse represents the most pressing concerns and the need for immediate assessment and intervention in this context.